Many women feel secure that estrogen protects against skeletal loss, and that it
is not until menopause with its plunging estrogen levels that their bones lose strength. Women with a concern
for health often begin taking calcium supplements protectively
years before the climacteric. If you are active, if you lift heavy groceries, if you drink milk,
if you watch your RDA and swallow your calcium, you may feel
that your measures are adequate. Sadly, that may not be the case.

I am not sedentary
and have never smoked. I started running in my 30s,
and developed a joy in fitness that was expressed in both aerobic
and weight-bearing ways. Exercise became a daily routine, almost
a necessity, which contributed richly to my life without controlling
it. (Okay, it controls it a little.) Long ago I developed a taste for low-fat, nutritious food.
Long ago I added calcium to my regimen of supplements. But I
am slight of build, and favor my fatherís mother. Recollection
of her frail, bended frame has always haunted me.

Most people fear some
physical impediment above others. My terror has always been
that my eventual fate is to shrink, to twist into painful
immobility, trapped inside a misshapen, easily-shattered
shell. At the age of 47, still menstruating, still active,
still purposefully directed toward health, I arranged a bone-mineral
density (BMD) scan. It is a fairly fast, painless procedure.
One lies supine as the x-ray device scans pelvis to ribs and
a bony image emerges on a nearby computer screen. I
wanted to allay my fears.

T-scores compare bone density of the patient
with that of a normal 30-year-old. The World Health Organization
defines osteopenia as bone-density T-scores of more than
one, and less than 2.5, standard deviations below the
mean; osteoporosis proper exceeds 2.5. With each standard
deviation below normal, risk of fracture approximately doubles.
Evaluation of my lumbar spine yielded a T-score of two
and one-third standard deviations below that of normal
bone density. The diagnosis was osteopenia, the
preface to osteoporosis. The presence of
estrogen failed to prevent a premenopausal bone fragility,
and the fate I feared was waiting in
the wings. But why?

Partial reasons present themselves.
I was a thin child and, with any food but spaghetti, an indifferent
eater. As a teenager, I fell headlong into all
the fast-food traps, and all through my 20s my eating habits
were erratic; thus, at the most important times of bone development,
long before cultivating my taste for nutritious food, my dietary
habits failed me. Family history is always important,
and my grandmother provided genetic reason. There
may be other hidden genetic reasons as well, such as possible
problems in utilizing vitamin D or calcium. Topical
corticosteroids I have used for years on eczema might have
contributed a small part. The average onset of
menses in girls is at the age of 12; mine occurred not until
the age of 16, and such pubertal delay might have its own
detrimental effect on bone mass. For reasons still being
explored, even a history of depression, for which I qualify,
has recently been connected with osteoporosis. If
my search for answers has not brought one immutable reason,
at least any unbounded faith in my current and longstanding
(but not longstanding enough), exertion-filled, vitamin-popping
lifestyle is restrained.

Remodeling
is constant in adult bone: At the cellular level,
osteoclasts destroy and osteoblasts rebuild it.
The process renews and repairs. But as we
age, rebuilding slows. Knowing that, we seek calcium and
consider ourselves safe. Many drink milk.
Although milk contains plenty of calcium, by deactivating
critical enzymes pasteurization prevents our bodies from
incorporating that source of calcium. Actually,
the belief that calcium protects against bone loss is
flawed. Even with vitamin D, even with magnesium,
calcium is not easily absorbed, and even if it makes its
way to the bloodstream its integration can be complicated
by genetic traits, including variations in vitamin D receptors,
that are just beginning to be understood.
Studies have plotted the decline of bone mass in women
who religiously swallow their calcium supplements.

Pharmaceutical remedies for bone loss are now available and, for many years, I was their ardent defender. These include estrogen, calcitonin, and a class of drugs called bisphosphonates. In common, they tend to inhibit bone resorption and even to increase bone mineral density. Estrogen therapy is often prescribed for women after their own production of estrogen has ceased. It is believed to inhibit bone resorption, and it can increase bone mineral density in the spine. But many women are unwilling to prolong menstruation, and breast cancer can be a concern with estrogen therapy. If hormones are to be used, in my opinion you should seek out someone who offers bioidentical hormones rather than synthetic ones. I have always thought it strange that, before menopause, estrogen has beneficial effects on many aspects of a woman’s body, but after menopause it suddenly becomes a harbinger of cancer and fails to protect the cardiovascular system. Why is that? Could it be related to the fact that most postmenopausal hormone therapy uses synthetic or nonhuman sources?

Calcitonin is a hormone secreted by the thyroid. Opposing the effects of parathyroid hormone, which pulls calcium from bone, calcitonin reduces calcium in the blood by inhibiting osteoclast activity as well as calcium absorption by both intestines and kidneys. To obtain the drug we purify calcitonin from salmon. It must be injected or inserted intranasally daily.

The class of drugs before which for some years I genuflected was the bisphosphonates, which bind to the bony matrix, inhibiting its breakdown, and are retained in bone for many years. Inhibition of bone resorption by bisphosphonates is robust, and because they either attach to bone or are excreted from the body without affecting anything else, when taken correctly bisphosphonates are apparently practically free of side effects—we thought. We now know that, as with any drug, side effects are unavoidable. And bisphosphonates come with some frightening baggage.

Believing that bisphosphonates were the savior of my skeleton, in all I took them about 11 years.

Bisphosphonates work by inhibiting the osteoclasts’ absorption of bone. ‘Inhibit’ is the word used by the industry, but in fact there is evidence that bisphosphonates may in fact kill osteoclasts. If so, are they ever regenerated?

What this does is unbalance the cycle of bone building and regeneration. Of course, presumably the cycle was already unbalanced and your bone was being lost, bringing the bisphosphonates into your life.

Take Fosamax (alendronate), for example, one of the first bisphosphonates available. I started taking it at least six years before menopause, as my premenopausal bone loss registered me as osteopenic. What happened in my body? Osteoblasts continued to build bone while osteoclasts, which normally ‘prune’ old bone away, were out of the picture. Thus the bone becomes ‘denser’ and initially stronger, much to my delight.

But now we realize that this denser bone is not necessarily healthier. ‘Old’ bone in the structure is not removed and so remains. So while the bone is denser, in time—after about five years of use--it is not stronger; in fact, it might even be much more brittle and frail.

After years of use, this imbalance of the skeletal cycle may begin to show side effects that at first nobody suspected might occur.

Some people experienced death of the jaw bone, a condition called osteonecrosis of the jaw. When the bone is dying it may be extremely painful and eventually may have to be removed. As you can imagine jaw removal is extremely disfiguring.

Another rare but disturbing side effect of long-term bisphosphonate use is sudden and complex fractures of the femur, the large thigh bone. These fractures can occur with no apparent reason and so are called low-energy; one woman was walking to the bus when she heard a snap and found herself on the sidewalk. Fractures occurring after use of Fosamax have certain features. In one study three quarters of 25 people fractured in a straight line across the bone, sometimes with a beak-like overhang on one side. In DEXA scans these bones did not appear to be osteoporotic; they looked strong even though they were far from it.

Bisphosphonates are used at higher doses for people with cancer of the bone. People so treated had higher instances of osteonecrosis of the jaw. This condition also occurred when people had dental work done, especially tooth extractions. However, these side effects can also occur in people with low doses of bisphosphonates.

Fortunately, there are things that you can do to resist the bone-destructive elements of the culture we live in. Yes, the Western diet is very far from optimal in ways that affect every aspect of health, and certainly our bones.

Balance of acidity to alkalinity is not only important for bone health, it allows us to live. The blood must maintain a strict balance in the pH level just above 7.0. Our enzymes, immune system, and healing mechanisms all perform best within a narrow margin. At the same time our own movements—exercise, eating, even just breathing—produce acids in the forms of carbon dioxide and lactic acid. When we react to pollen or pollutants, these and other stressors generate acids.

Our organs help us overcome these imbalances. The lungs expel carbon dioxide and acids with every exhalation and regardless of what we eat. For the kidneys, however, the ability to excrete acids is contingent on what we ingest. When we eat raw or lightly cooked vegetables, nuts, fruits, and seeds, we take in alkalinity to balance the acids we constantly produce.

But most of the time how many of us eat that way? The Western culture promulgates a high level of acidifying foods. Many grains are acidifying and more so when they’re refined. Protein and refined sugar form acids. When our diet is high in animal protein, processed and refined foods, and caffeine or alcohol (or both), we can actually exist in a chronic state of mild acidosis. And when acidity is high, the kidneys compensate by using alkaline reserves, one of which exists in our bones, to buffer the acidity.

On the other side of the equation, most fruits, vegetables, seeds, nuts, spices, herbal teas, and natural sea salt (which contains micronutrients lost when processed) tend toward the alkaline. Ideally, according to Susan Brown, PhD (an anthropologist with a cross-cultural perspective on osteoporosis), our diet should be 65% alkaline and 35% acid, although the ratio should be higher when we’re correcting a longstanding imbalance. How can you tell if you are achieving the right balance? Litmus papers are available from drug stores.

You probably already realize that exercise is good for bones as well as the rest of your body. But exercises don’t necessarily benefit all of your bones. Running, walking, and hiking are great for your hips. If you want to strengthen your spine, however, you have to do to it what those other activities do to your hips, and that is place weight on it. The best way to do that is to lift weights. You don’t have to buy bar-bells; simple hand-weights will do. Get a weight that you can lift easily with one arm, but that has enough heft that you will feel those repetitions. When you press the weight above your head or, if lying down, above your chest, the weight on the spine will stimulate the bone-building cycle.

Another way to put weight on your spine is through wearing a weighted vest. If you’re inclined to walk to the store, don a weight vest first and make it count even more. If you’re taking a hike, add a weight vest and virtual hills to your route! Be aware that most weight vests are constructed so that a belt around your waist takes the pressure off your shoulders, and taking that weight off your shoulders also takes the weight off your spine. Some of the soft, leaded vests, by distributing the weight over their entirety while remaining soft on your shoulders, will overcome that drawback and retain the weight stimulation to your spine.

In a perfect world we would not need supplements. Why can’t our diets supply what they supplied for millennia to our ancestors? Several things are at work here. For one thing we live longer, and much of that is owing to better overall diet—often supplemented with vitamins and minerals. At the same time the quality of the food we eat, even organic, is generally on the decline. Some of this decreasing quality is owing to exposure to chemicals, hormones, and pollution in the air and water. But a great part of it has to do with the quality of our soil. Soil loses quality to topsoil-stripping wind, chemical fertilizers, and nutrient exhaustion from over-planting. The area of our land devoted to agriculture is continually being diminished by encroaching pavement. Plants grown in over-used and under-cared-for soil naturally do not contain the nutrients they traditionally bore. Increasingly we are abusing our topsoil in another way, too, and in a potentially lethal way, through the planting of genetically modified crops.

So in this world we have to rely to some extent on supplements.

When you think of supplements for bone health, what pops into the minds of many is calcium. Much of the bony matrix is composed of calcium. But it is hardly alone, and taking calcium without other vital nutrients can actually be worse on your bones than taking none at all. And in addition to failing to help your bones, taking calcium supplements alone might even increase your risk of heart attack.

Calcium is but one of the minerals needed for a strong skeleton. Think of your bones, as well as your health, as being composed of a potpourri of minerals and nutrients, many of which are best obtained through diet.

With vitamin D we can bypass the diet-versus-supplement dilemma. You may know that vitamin D is good for bone (along with many other things). Most people for much of the year can get their vitamin D from judicious exposure to sunlight. If you live in an area with insufficient sunshine and must supplement with vitamin D3, be sure to include vitamin K2 as well to prevent the heart disease that taking vitamin D alone can bring. Vitamin K2 helps to prevent calcium from adhering to your blood vessels and also is needed to bind calcium to bone. Especially if you get your vitamin D from the sun, you can also get your vitamin K from green, leafy vegetables, such fermented foods as natto, and raw milk cheeses. Another useful vitamin easily obtained by eating fresh fruit and many vegetables is vitamin C. Vitamin C helps promote healthy bone renewal. Vitamin B12 is a water-soluble B vitamin that some people can begin to have trouble deriving from food as they get older. It too may be necessary for skeletal health, as a rather large study has shown an association between B12 deficiency and osteoporosis. Most people also benefit from high-quality omega-3 fatty-acid supplement such as one derived sustainably from krill oil.

As much as possible, get your nutrients from a well-balanced, fresh, often raw, organic-as-much-as-possible, non-GMO diet. Get enough good sleep and exercise. Try to determine which of your nutrient levels need supplementation and do so accordingly.

Whatever you do, do not assume uncritically that, in the absence of such secondary causes as renal failure or hyperthyroidism, a woman’s skeletal resorption does not commence in earnest until menopause shrinks the estrogen supply. My spine argues otherwise. Apply some of the remedies noted above, even if your doctor tends to minimize them. And don’t feel exempt from the specter of bone loss simply because you’re a man. Whatever your age and whichever your sex, if you have risk factors for osteoporosis, investigate that risk. Don’t await that first fracture.

Aside from these chemical treatments, veterinarians have been exploring an incredible possibility. What if vibration strengthened bone? Skeletons of sheep with induced osteoporosis have been building bone in response to short, 20-minute daily intervals of low-frequency sonic vibration (personal communication, 1999). Soon it may be possible to obtain one's skeletal strengthening from a daily encounter with select vibrations.